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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2009

01-08-2009 | Gastrointestinal Oncology

Prevention of Severe Pelvic Abscess Formation Following Extended Radical Surgery for Locally Recurrent Rectal Cancer

Authors: Mamoru Uemura, MD, PhD, Masataka Ikeda, MD, PhD, Mitsugu Sekimoto, MD, PhD, Naotsugu Haraguchi, MD, PhD, Tsunekazu Mizushima, MD, PhD, Hirofumi Yamamoto, MD, PhD, Ichiro Takemasa, MD, PhD, Hideshi Ishii, MD, PhD, Masaki Mori, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2009

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Abstract

Background

For treatment of locally recurrent rectal cancer (LRRC), extended radical surgery is sometimes required to obtain a negative margin. Such surgery is often associated with severe postoperative pelvic abscess (PA) formation. The aim of this study was to determine the effects of reconstructive surgery using a large rectus abdominis myocutaneous (RAM) flap and anal preservation surgery on the incidence of severe PA.

Method

Between February 1998 and June 2008, 44 patients underwent extended surgery for LRRC. Patients were divided into the pre-2004 group (n = 15) and the post-2004 group (n = 29). To reduce the risk of infections, we modified the surgical approach after 2004 to include a larger volume of RAM flap (modified RAM flap) and implemented anal preservation surgery.

Results

The overall incidence of severe PA was significantly lower in the post-2004 group [6 of 29 (21%)] than the pre-2004 group [9 of 15 (60%), P = 0.017]. The incidence of severe PA was lower in the anal preservation group [1 of 12 (8.3%)] compared with those who did not undergo such surgery [14 of 32 (44%), P = 0.035]. Modified RAM flap reduced the incidence of severe PA, albeit insignificantly (pre-2004 group: 57%, post-2004 group: 23%). All three patients who underwent anal preservation and modified RAM flap reconstruction did not develop severe PA. Multiple logistic analysis identified no anal preservation (Odds ratio [OR] = 10.6) and performing of sacrectomy (OR = 20.0) as risk factors for severe PA.

Conclusion

Anal preservation surgery is an effective measure against the development of severe PA after radical resection of LRRC.
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Metadata
Title
Prevention of Severe Pelvic Abscess Formation Following Extended Radical Surgery for Locally Recurrent Rectal Cancer
Authors
Mamoru Uemura, MD, PhD
Masataka Ikeda, MD, PhD
Mitsugu Sekimoto, MD, PhD
Naotsugu Haraguchi, MD, PhD
Tsunekazu Mizushima, MD, PhD
Hirofumi Yamamoto, MD, PhD
Ichiro Takemasa, MD, PhD
Hideshi Ishii, MD, PhD
Masaki Mori, MD, PhD
Publication date
01-08-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 8/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0505-6

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